Progressive Control Pathway (PCP) and Regional Roadmaps : -towards a common framework for long term action against FMD at national and regional levels focus on Eurasia and AfricaPresentation[1] to the OIE/FAO Global Conference on FMD, Asuncion, Paraguay

[1] Prepared by:

Sumption K (1) , Lubroth J (2) , Ferrari G (2), Potszch C (1) , Domenech J (2)(1) European Commission for the Control of Foot-and-Mouth Disease (EuFMD), FAO, Rome, Italy, (2) EMPRES Animal Health,

AGAH, FAO, Rome, Italy

Stages 0-3 = infected countries/zones

Risk not controlledContinuous FMDV circulation

Critical risk points identified,strategy being developed

Critical points addressed incidence

Approaching freedomOutbreaks < once / year

Officially free with vaccinationNo circulation / containment zones only

0

1

2

3

4

Officially free without vaccinationNo circulation / containment zones only5

Global Control through Regional Roadmaps for each of the seven virus pools

a recommendation of the Open Session of the EuFMD research group held in Erice, Sicily, October 2008

7 virus pools recognised by the OIE/FAO FMD lab networkdiffer in FMDV antigenic types/required vaccines, risk factors

and control capacities, requires tailored approach FAO follow-up has been to develop the PCP approach

– first applied at the Shiraz Regional Workshop in November 08

The seven major virus pools; basis for action against the regional virus types

Continual virus circulation and evolution within regional pools

Epidemic jumps between pools and to free regions (arrows)

1

23

4

5

6

7

Why Regional Roadmaps?

Regions have common risk features

different FMDV variants – vaccines must be selected for regional strains

flourishing intra-regional animal movement patterns porous landborders – informal trade

high intra-regional differences in capacity to control movements/FMD

one or more economic or political integration organisations regional animal health mechanisms –

GfTADS Steering Committees OIE/FAO Regional Animal Health centres, etc

National capacity and action against FMD

enormous variation in investment in FMD control within Regions

questions can more impact be achieved for the same level of investment?

impact on incidence, reduce virus circulation, eradicate for countries with almost no current investment, what can be

done? that will:

create conditions for investment (benefits)? generate FMDV information to build future national strategy? assist regional risk-reduction efforts?

If we promote national efforts, how can we objectively measure progress?

the need for comparative indicators compare progress

within a Region between Regions

self-assessment at National level provide progress indicators for donors/investment

lessons from HPAI and PVS

The Progressive Control Pathway for FMD (PCP-FMD) and Regional Roadmaps

PCP-FMD: is a set of control program activity stages leading to FMD freedom

Regional Roadmaps (RR) describe the anticipated progress along the PCP at national and regional level over longer term (e.g. to 2020)

PCP at national level and RR at regional level- the suggested approach of FAO for long-term co-ordinated action

against FMD.

PCP – stepwise along the road

Country Stages -facilitate progress monitoring

at national and regional level

Global scale -across Regional Roadmaps

and at every stage generates information for risk assessment

Stages 0-3 = infected countries/zones

Risk not controlledContinuous FMDV circulation

Critical risk points identified,strategy being developed

Critical points addressed incidence

Approaching freedomOutbreaks < once / year

Officially free with vaccinationNo circulation / containment zones only

0

1

2

3

4

Officially free without vaccinationNo circulation / containment zones only5

FAO Progressive control pathway - risk reduction approach

•not a top down prescribed approach: but each MS encouraged to develop national risk reduction strategies that are supportive to the regional effort

Official recognition of FMD freedom

responsibility of the OIE zone or country basis with or without vaccination requires minimum period of 12-24 months without evidence of FMD

infection/circulation There is considerable latitude available to OIE Members to provide a

well-reasoned argument to prove the absence of FMDV infection (in non-vaccinated populations) or absence of circulation (in vaccinated populations) at an acceptable level of confidence

does not prescribe how to control FMD

uses HACCP principles: addressing critical control points

starts with risk/critical control point identification

promotes targeting of resources to critical risk control points

progressive increase in surveillance requirements

culminates in meeting requirements for official recognition of freedom

The PCP approach – principles:

PCP criteria, tools, guidelines

criteria – tested in 4 workshops/surveys surveillance principles developed

require refinement, validation PCP technical support and evaluations

currently by FAO staff but training could be provided linkage to PVS

criteria for progress could include PVS evaluation and follow-up

Risk not controlledContinuous FMDV circulation

Critical risk points identified,strategy being developed

Critical points addressed incidence

Approaching freedomOutbreaks < once / year

Officially free with vaccinationNo circulation / containment zones only

0

1

2

3

4

Officially free without vaccinationNo circulation / containment zones only5

FAO Progressive control pathway - risk reduction approach

•not a top down prescribed approach: but each MS encouraged to develop national risk reduction strategies that are supportive to the regional effort

Stages 0-3 = infected countries/zones NOT an official status the common feature of all stages is the

measurement of FMD infection/circulation in the population at risk

the difference is the level of control of transmission/risk

Stage 0: risk not controlled

Stage 0: characteristics when: level of virus circulation (prevalence in serological studies) has not been

studied in past 12 months; and/or: outbreaks occur every year and: the impact of control measures (vaccination, quarantines) on virus

circulation is not studied or measured

Risk not controlledContinuous FMDV circulation

Stage 0

many countries! whether vaccinating or not

countries that [deliberately?] do not report FMD ....and do not report results of serological surveys are automatically in Stage 0

Stage 0 in red

vaccination against FMD in 2008 in Africa

Mass vaccinationZonal vaccinationlow vaccination rationo vaccination

Most subsaharan African countries are in Stage O, with very low vaccination rates:

PCP 2009

Stage 1: critical FMD risk points assessed, national strategy under development

Stage 1: characteristics when: level of virus circulation (prevalence - NSP positives) has been studied

in past 12 months, and indicates virus circulation has occurred the critical risk points associated with the major husbandry/marketing

chains are being identified ; and:

a strategy is under development to address the CRP

Critical risk points identified,strategy being developed

Stage 1 – low cost

serological survey to identify incidence and risk groups identify FMDV strains identify Critical Control Points (CCP) identify capacity to control and identify willingness to pay develop strategy

provides valuable surveillance data for risk assessment therefore Stage 1 activities of regional value

Application:progressive risk reduction Eastern Turkey/Caucasus/Iran/Iraq/Syria

Type A:11Type O:38Untyped:25

19Source: GDPC, Ankara 1st June

2009

FMD outbreaks in Turkey, 2009 (UP TO 21th May)

0 %

> 0 - 20%

> 20 - 40 %

> 40 - 60 %

> 60 %

not sampled

Regional NSP situation – four country sero-survey Sampling Mid-2008 in 6-24 month animals (true prev.)

Critical control points..........

Stage 2: FMD under control, circulation is progressively reduced

Stage 2: characteristics when: each new outbreak(s) is investigated and potential sources identified level of virus circulation (prevalence in serological studies) has been

studied repeatedly for at least 24 months, and evidence of FMDV exposure found in each survey

the risk associated with the major husbandry/marketing chains identified, and strategies implemented for each ;

and: the impact of control measures (vaccination, quarantines, measures at borders) on virus circulation is being measured

Critical points addressed incidence

Stage 2: can be high cost

usually involves vaccination but does not prescribe national mass vaccination expected that some countries will choose not to effectively

implement Stage 2 lack of economic incentives and finance importance of regional political pressure and support potential incentives: FMD controlled compartments/commodity

based trade

I.R of Iran:progressive control despite epidemic incursions of variant

FMDV

A 05 BAR08

In country movements

Breeders areas

Breeders areas

Breeders areas

Fattening areas

Nomadic movements

Iran: Vaccination program differs between production systems and risk regions

Intensive dairy cattle units sequential program / every 4 months

Intensive Fattening units permanent program (pre-entry)

Villages / High risk areas sequential program / every 4 months

Nomadic herds yearly program in high risk areas

Vaccination is often not enough.....

very high Ro of virus high vaccination cover rarely

enough gaps remain critical control points need to

be addressed - stop virus finding gaps

Kevenlik, Turkey: June 4th, 2009

Stage 3: Approaching freedom; effective prevention and containment measures

Stage 3: characteristics when: each new outbreak(s) is shown to originate outside of the country or zone, not

originate within; level of virus circulation (prevalence in serological studies) has been studied

repeatedly for at least 24 months, and evidence of FMDV exposure found but being restricted to limited foci or limited time periods;

each cluster of infection or outbreaks have a plausible explanation, through outbreak tracing;

each outbreak or evidence of infection is followed up by immediate measures and post-outbreak surveillance, and review of the impact of control measures (vaccination, quarantines, measures at borders)

Approaching freedom“FMD Events” < once / year

Stage 3:

good level of contingency planning access to vaccine reserves/banks for emergency rapid response to risk ability to regulate animal movement;

example: several North African countries in response to the type A Iran 05

incursion into Libya in 2009

by 2020, all at least in Stage 3

Stage 4: Officially Free with vaccination

Stage 4: characteristics official recognition on zone or country basis by the OIE requirements set out in the Terrestrial Animal Health Code

Stage 4: for inclusion in the list of FMD free countries where vaccination is practised, a Member should:

have a record of regular and prompt animal disease reporting; send a declaration to the OIE that there has been no outbreak of FMD for the past 2 years and no evidence of FMDV circulation for the past

12 months, with documented evidence that: surveillance for FMD and FMDV circulation in accordance with Articles 8.5.40. to 8.5.46. is in operation, and that regulatory measures for the prevention and

control of FMD have been implemented; routine vaccination is carried out for the purpose of the prevention of FMD; the vaccine used complies with the standards described in the Terrestrial Manual.

Officially free with vaccinationNo circulation / containment zones only

The PCP and Roadmap in practice

Regional assessments – PCP Regional meetings – develop Roadmaps Political/donor meetings – advocacy and agreement on type

of support

West Eurasia Africa (4 subregions)

Vision for the West EurAsia Roadmap for FMD Control: freedom from clinical disease by 2020

Regional cooperation among Eurasian countries ...............

for the progressive control of FMD through public and private partnerships

leading towards freedom of clinical disease by 2020 for regional economic development, food security, and poverty alleviation.

KazakhKyrgyzTajikTurkmenUzbek

AFGIRNPAKTURKThraceadded zonesSyriaIraqArmeniaAzerbaijan

GeorgiaCountries 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Wes

t Eur

asia

N Z

Level 0

hatched 0درجة

Level 1 1درجة

Level 2 2درجة

Level 3 3درجة

RoadmapWest EurAsia – Roadmap to 2020 - expected country progression (Shiraz Meeting Report, 2008)

Agreed timetable for Africa

Countries 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Algeria Egypt Libya Mauritania Morocco Tunisia Benin

Burkina Faso Cote D'Ivoire Gambia Ghana Guinea Guinea-Bissau Liberia Mali Niger Nigeria Senegal Sierra Leone Togo Cameroon Cape Verde

Central African Republic Chad Congo (Dem. Rep. of the) Congo (Rep. of the)

Equatorial Guinea Gabon Sao Tome and Principe

Djibouti Eritrea Ethiopia Kenya Somalia Sudan TanzaniaBurundiRwanda Uganda Angola ?? 4/5 4/5 Botswana 3z/5 3z/5 3z/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 Comoros Lesotho 5 5 5 5 5 5 5 5 5 5 5 5 Madagascar

Malawi 4/5 Mauritius Mayotte (France) Mozambique

4/5 Namibia 4z/5 4z/5 4z/5 4z/5 4Z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 Reunion (France) Seychelles South Africa

4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 Swaziland 4/5 Zambia 4z/5 4z/5 4z/5 4z/5Zimbabwe 0 0 1 1 1 1 3 3 3 3 3 4z/5

By 2020, th Vision statement agreed at the Final Plenary Session, 30th January N ZVision statement for North Africa agreed at the OIE General Session, 26th May (Paris) Level 0

Level 1Level 2Level 3Level 4Level 5

Wes

tern

Afri

caC

entra

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caE

ast A

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Nor

th A

frica

Sou

th A

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Africa Roadmapsto 2020

Expected PCP progression,

North, West/Central,

East and Southern Africa

(Nairobi Workshop, Jan 09 and Algiers,

Feb 09)

2009 2020

Africa Roadmap progression to 2020– after Nairobi and Algiers Workshops

Vision - 2020

What do we hope for this OIE/FAO Global FMD conference? (Paraguay, June 2009) adoption and application of the PCP approach from 2009 Regional Roadmaps covering all 7 major endemic regions:

in place and active from 2010 global monitoring - ANNUAL published progress monitoring

(OIE/FAO)

Outcomes: reduced incidence in every Roadmap country reaching stage 2 most endemic countries in stage 2 or above by 2020 safer trade from an increased number of countries

Acknowledgements

EUFMD Commission member states EC (DG-SANCO –Regional workshops) FAO (J. Domenech, J. Lubroth, G Ferrari, J Pinto) OIE (G. Bruckner) African Union-IBAR (Pan African Workshop) FAO World Reference Laboratory (WRL) Pirbright (D Paton)

Supporting centres: EUFMD Secretariat staff (Nadia Rumich) RAHCs in Nairobi, Bamako, Beirut, Tunis, Gaborone, Nepal